Pre-service Authorization Specialist

3 weeks ago

South Bend, United States Saint Joseph Health System Full time

**Employment Type**:
Full time

**Shift**:
Day Shift

**Description**:
**JOB SUMMARY**

Obtains accurate authorization and billing information to effectively authorize/pre-certify all patients entering Saint Joseph Health System (SJHS). Provides third party benefit verification for identified patients and other issues regarding the responsibilities to the related care plans.

**JOB DUTIES**

Validates medical necessity (LCD/NCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Contacts scheduling and/or ancillary department staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s). Performs other duties consistent with purpose of job as directed.

**JOB SPECIFICATIONS AND CORE COMPETENCIES**

**Education**:High school education required. Some post-secondary education preferred specifically in business or healthcare.

**Licensure**:CHAA preferred.

**Other Job Requirements**:
Ability to read, analyze and interpret Medicare compliance regulations.

Ability to calculate figures and amounts such as discounts, co-insurance, co-pays and deductibles.

This position requires a professional appearance.

Superb customer service skills required over the phone and in person.

Must be able to travel to all patient access sites.

Working knowledge of medical terminology desirable. Basic computer skills are required.

Performs job responsibilities to the highest standards and delivers "something more" that ensures a more complete and personally satisfying experience for every customer.

Must be willing to participate in continuing education seminars as related to patient access.

**Our Commitment to Diversity and Inclusion**

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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